In September 1993, I began a full-time position as a Skilled Nurse doing visits and shifts for a Home Health care agency. I had sporadically worked some midnight shifts for this agency six months prior to joining full-time. Meanwhile, I had been working 12 hour midnight shifts full-time at a small local hospital on the Med/Surg unit and in the ER. I decided to leave that position when the Home Health position was offered. I loved the one-on-one relationship with the patient and family. And, as an added benefit, I would be making a better salary.
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After about a month of working full-time as a visiting nurse, I was offered the position of Nursing Supervisor. The Administrator and Director of Nursing noted that they believed me to be "a motivated quick learner". My responsibilities would include management of the cases and the staff providing Skilled Nursing services to the Medicare hourly and visit cases.
Medicare had recently begun authorizing benefits to homebound Psychiatric patients. The Administrator of the Home Health care agency requested that I institute a program to serve this population. Having had a few years of Psychiatric experience, I was qualified to institute and manage such a program, according to Medicare guidelines. To the best of my knowledge, it was the first "At Home Mental Health Care" program in the Midwest.
It was exciting to think that I was on the cutting edge of patient care. I had ten years experience working as a staff nurse in a hospital setting. Now, I was managing staff and cases in a Home Health agency while instituting a revolutionary new program!
I worked diligently, learning the responsibilities of my position and setting up the new program, when the Christmas holidays rolled around.
Skilled Nursing shifts and visits are typically a chore to cover, when many of the nurses have either regular full-time positions or work elsewhere for other agencies. The Christmas holidays are even a bigger chore, as most of the nurses are committed to other jobs, or merely want to spend quality time with their families.
The Staffing Coordinator informed me one of the cases I managed had an open midnight shift she could not get coverage on Christmas Eve. The patient was an 18 year old female who was on a vent as a result of her neuromuscular disorder.
I have no children. My wife was planning to spend the holidays visiting some out-of-town relatives stayng at her mother's house. My absence from the festivities Christmas Eve would not hinder anyone's happiness to any great degree. I opted to work the midnight shift. I believed that it would not only provide the needed Skilled Nursing care, and keep the agency in good standing with the client, but would also be an example to the nurses I managed: Their Supervisor was ready to pick up the ball and run it in when times got tough.
Then, the Staffing Coordinator informed me of another case she was experiencing difficulty covering: An elderly male patient, currently in the hospital, was being discharged Christmas Eve. He had been hospitalized as a result of an exacerbation of his chronic cardiac condition. The Attending Physician would only authorize discharge if a nurse would assess the patient within 24 hours. No Visiting Nurses were available to assess the patient and open the case.
I reviewed the patient information and his home location. I could, relatively easily, open the case on the way to my midnight shift. It would be a long night, but I foresaw little difficulty.
"Little difficulty" is an understatement. I experienced the joyousness of families comforted by the visit of a medical professional to oversee the care of their loved ones during this "holiest of holidays".
It was an experience I love to recall.
One morning, a few days after Christmas, I received a telephone call in my office. The call was from the daughter of the elderly man whose case I had opened on Christmas Eve. She called to inform me that her father had passed away, just that morning. But she didn't call only to give me news of his passing. She wanted to let me know how much she and her family appreciated my involvement in their lives. Had I not been able to provide Skilled Nursing services for her father, he may have not been able to be discharged from the hospital. He may have not been able to spend his last Christmas at home with his loved ones. For this, she was very, very grateful.
